Endovascular treatment simulations using a novel in vitrobrain arteriovenous malformation model based on three-dimensional printing millifluidic technology

Background Brain arteriovenous malformations (bAVM) are complex vascular diseases. Several models have been used to simulate endovascular treatments; thus in vitromodels have not been widely employed because it has been difficult to recreate realistic phantoms of this disease.Objective To describe the development and evaluate the preliminary experience of a novel bAVM in vitromodel for endovascular embolization using millifluidic three-dimensional (3D) printing technology.Methods We designed a bAVM phantom starting from simple to more complex designs, composed of a nidus, feeding arteries and draining vein. We recreate the design by using millifluidic technology with stereolithography 3D printing. Structural and functional tests were performed using angiographic images and computer flow dynamics. Treatment simulations with ethylene vinyl alcohol were tested using two different microcatheter position techniques. A Likert-scale questionnaire was applied to perform a qualitative evaluation of the model.Results We developed a realistic model of a bAVM with hollow channels. The structural evaluation showed a high precision of the 3D printing process. Embolization tests with the liquid agent gave similar sensations and material behaviour as in vivocases. There were no significant differences between microcatheter position techniques, thus we observed a trend for better nidus filling with a deeper in-nidus position technique.Conclusions We were able to create and test a novel bAVM in vitromodel with stereolithography 3D printing in resin. It showed a high capacity for simulating endovascular embolization characteristics, with an excellent user experience. It could be potentially used for training and testing of bAVM embolizations.